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Shared decision-making and health care expenditures among children with special health care needs
Alexander G Fiks1, Stephanie Mayne, A Russell Localio
1The Pediatric Generalist Research Group (PeRC), The Children's Hospital of Philadelphia, 3535 Market Suite, Room 1546, Philadelphia, PA 19104, USA. fiks@email.chop.edu
Insights
Increasing shared decision-making (SDM) in children with special health care needs (CSHCN) is linked to lower healthcare costs and reduced service use. Further research can confirm if promoting SDM lowers care expenses for families and health systems.
Area of Science:
- Health Services Research
- Pediatric Health Economics
- Patient-Centered Care
Background:
- Children with special health care needs (CSHCN) often incur significant healthcare expenditures and utilization.
- Shared decision-making (SDM) is a collaborative process involving patients and clinicians in healthcare choices.
- Understanding the economic impact of SDM for CSHCN is crucial for healthcare policy and resource allocation.
Purpose of the Study:
- To investigate the association between patterns of shared decision-making (SDM) and healthcare expenditures and utilization among CSHCN.
- To quantify the impact of changing SDM levels on the financial and service use outcomes for CSHCN.
Main Methods:
- Utilized data from the 2002-2006 Medical Expenditure Panel Survey, identifying CSHCN using the CSHCN Screener.
- Categorized SDM patterns over two study years as increasing, decreasing, or unchanged (high or low).
- Assessed the impact of SDM patterns on changes in total healthcare expenditures and service utilization, including office visits, hospitalizations, and emergency department (ED) visits.
Main Results:
- The study analyzed 2,858 subjects representing 12 million CSHCN.
- Increasing SDM was associated with a significant decrease in total healthcare costs ($339 per child) over two years.
- Increasing SDM correlated with reduced hospitalization rates, ED visits, and office visits, as well as lower total and out-of-pocket expenditures compared to decreasing SDM.
Conclusions:
- The findings indicate a significant association between increasing shared decision-making and decreased healthcare utilization and expenditures for CSHCN.
- Further prospective research is recommended to validate whether actively promoting SDM can lead to cost reductions in the care of CSHCN for both healthcare systems and families.
Background And Objectives:
To understand the association between shared decision-making (SDM) and health care expenditures and use among children with special health care needs (CSHCN).
Methods:
We identified CSHCN <18 years in the 2002-2006 Medical Expenditure Panel Survey by using the CSHCN Screener. Outcomes included health care expenditures (total, out-of-pocket, office-based, inpatient, emergency department [ED], and prescription) and utilization (hospitalization, ED and office visit, and prescription rates). The main exposure was the pattern of SDM over the 2 study years (increasing, decreasing, or unchanged high or low). We assessed the impact of these patterns on the change in expenditures and utilization over the 2 study years.
Results:
Among 2858 subjects representing 12 million CSHCN, 15.9% had increasing, 15.2% decreasing, 51.9% unchanged high, and 17.0% unchanged low SDM. At baseline, mean per child total expenditures were $2131. Over the 2 study years, increasing SDM was associated with a decrease of $339 (95% confidence interval: $21, $660) in total health care costs. Rates of hospitalization and ED visits declined by 4.0 (0.1, 7.9) and 11.3 (4.3, 18.3) per 100 CSHCN, and office visits by 1.2 (0.3, 2.0) per child with increasing SDM. Relative to decreasing SDM, increasing SDM was associated with significantly lower total and out-of-pocket costs, and fewer office visits.
Conclusions:
We found that increasing SDM was associated with decreased utilization and expenditures for CSHCN. Prospective study is warranted to confirm if fostering SDM reduces the costs of caring for CSHCN for the health system and families.
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